Suicide in Indian women
Authors: Rahul Shidhaye
Journal: The Lancet Public Health (2023)

WHO estimates that more than 700 000 individuals die by suicide every year.1WHOSuicide in the World: Global Health Estimates. World Health Organization, 2019https://www.who.int/publications/i/item/suicide-in-the-worldDate accessed: March 16, 2023Google Scholar According to the National Crime Record Bureau (NCRB), 164 033 suicides were reported in India during 2021.2Government of India National Crimes Record BureauAccidental deaths and suicides in India.https://ncrb.gov.in/en/accidental-deaths-suicides-in-indiaDate accessed: March 16, 2023Google Scholar Being the second most populous country in the world, the share of India in global suicides is expected to be high. However, the suicide death rate (SDR) in India is higher than the global average, especially in women. The age-standardised suicide rate of 11·1 per 100 000 for Indian women is more than double that of the global age-standardised suicide rate of 5·4 per 100 000 for women.1WHOSuicide in the World: Global Health Estimates. World Health Organization, 2019https://www.who.int/publications/i/item/suicide-in-the-worldDate accessed: March 16, 2023Google Scholar To mitigate these preventable deaths by suicide, it is crucial to understand who is more vulnerable, what demographic and socioeconomic factors are associated with suicide in Indian women, and how they die by suicide. Few epidemiological studies from India have focused on these factors. The most recent study was published in 2020, and the authors presented the risk factors associated with non-fatal suicidal thoughts and behaviour.3Amudhan S Gururaj G Varghese M et al.A population-based analysis of suicidality and its correlates: findings from the National Mental Health Survey of India, 2015–16.Lancet Psychiatry. 2020; 7: 41-51Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar These findings were based on the National Mental Health Survey of 2015–16. No Indian study to date has exclusively assessed the risk factors associated with suicide in women. This important knowledge gap is addressed by Rakhi Dandona and colleagues,4Dandona R George S Kumar GA Sociodemographic characteristics of women who died by suicide in India from 2014 to 2020: findings from surveillance data.Lancet Public Health. 2023; 8: e347-e355Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar as they explore the trends, reasons for suicide deaths and means of suicide among women from 2014–20. On the basis of their analysis of NCRB data, the authors found that there was an overall decrease of 4·5% in the SDR for women from 2014 to 2020. Economically developed states in India had higher SDR than less developed states. The SDR for the more developed states decreased whereas for the less developed states there was a slight increase in SDR during 2014–20. There are two noteworthy findings. First, the SDR increased with increase in education up to class 9–12 (age group 14–15 years to 17–18 years), and then decreased in women who completed graduation or higher education. Second, the SDR for women currently married compared with those never married was noteworthy. In 2014, women who were currently married had a higher SDR whereas in 2020, the SDR was higher for those who never married. SDR was highest in the 45–59 age group and in women who were unemployed. The most common reason for suicide was family problems, and hanging was the leading means of suicide.4Dandona R George S Kumar GA Sociodemographic characteristics of women who died by suicide in India from 2014 to 2020: findings from surveillance data.Lancet Public Health. 2023; 8: e347-e355Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar Dandona and colleagues' Article4Dandona R George S Kumar GA Sociodemographic characteristics of women who died by suicide in India from 2014 to 2020: findings from surveillance data.Lancet Public Health. 2023; 8: e347-e355Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar provides a comprehensive assessment of suicide deaths and sociodemographic factors associated with these deaths among Indian women over a period of 7 years. The authors primarily used NCRB data, and explained the limitations of this data source. The denominator used to calculate SDR for various education, marital status, and occupation categories was based on estimates from the National Sample Survey data, and the Global Burden of Disease study state-wise annual population estimates were used for age categories. This approach helped in translating the absolute number of suicide deaths provided by the NCRB into SDRs for the categories within the studied variables. It is important to note that the estimates for education, marital status, and occupation are unadjusted SDRs. Given the correlation between these variables, it would have been interesting to see the adjusted SDR estimates. However, the nature of the NCRB data precludes this kind of analysis. The findings of this study underline the importance of further investigating the association between sociodemographic factors and suicides in women. Future studies should explore the reasons behind the decrease over time in SDR and why the decrease is greater in more developed states in India. It is not clear how education is associated with suicides in women, given that women with the highest education levels (graduation or higher) have similar SDRs as women with no education. Reasons for increase in SDR for women who never married and decrease in SDR for women currently married during the same time frame requires further exploration. Hopefully, the findings of this study and the research gaps identified by the authors could be used by policymakers and research funding agencies to support future large-scale epidemiological and in-depth qualitative explorations. Suicide mortality rate is one of the indicators of the Sustainable Development Goals. Understanding who dies by suicide, for what reasons, and how, is an important step in the development and implementation of context-specific suicide prevention plans for different regions in India. This study is an important contribution towards that goal. RS is supported by the DBT-Wellcome Trust India Alliance Intermediate Fellowship in Clinical and Public Health Research. Sociodemographic characteristics of women who died by suicide in India from 2014 to 2020: findings from surveillance dataThe higher SDR among women who have received an education, similar SDR between women currently married and never married, and variations in the reasons for and means of suicide at the state level highlight the need to incorporate sociological insights into how the external social environment can matter for women to better understand the complexity of suicide and determine how to effectively intervene. Full-Text PDF Open Access